Laurance Jerrold

Risk management strategies in orthodontics. Part 2: Administrative considerations

Orthodontic practice results in relatively few patient challenges and litigations. This often leads to a false sense of security and encourages orthodontists to optimize practice management techniques that may be at odds with risk management considerations. Examples include excessive duty delegation to dental auxiliaries, office designs that invade patient privacy, and 1-visit consultations that have the potential to compromise the diagnosis and treatment planning process. Practitioners need to consciously balance risk management techniques against practice management initiatives. The strategies and opinions expressed do not necessarily represent the opinions of the American Journal of Orthodontics and Dentofacial Orthopedics, the American Association of Orthodontists, the American Board of Orthodontics, or the College of Diplomates of the American Board of Orthodontics.

What record is playing

Am 0889 Copy http: tists, it seems that a rising number of people are taking only intraoral and extraoral photographs along with a panoramic radiograph as their initial and final records and are not taking study models. In addition, they are only taking a cephalometric radiograph if they feel the case warrants one. I am presuming they believe they can make a proper diagnosis using just the photos and a pan. As a young orthodontist, the potential for litigation and making sure I have all the necessary records for each patient has strongly been ingrained in me. What is the legal standard of care relating to what orthodontic records need to be acquired? Thanks, D. K.

Admissibility of scientific evidence

What makes some scientific evidence admissible? Who makes this decision? These questions formed the basis of a recent article in the Journal of the New York State Bar Association entitled “Scientific proof: the courts role as gatekeeper for admitting scientific expert testimony.” The first item of note is that in our legal system, the trial court judge is accorded tremendous responsibility and leeway in deciding what type of scientific evidence to allow at trial as well as its method of presentation to the trier of fact. In essence, there is a bifurcation, since the trial judge becomes the trier of law, deciding who may testify, what they may testify about, and the method of presentation concerning the evidence. The jury then becomes the trier of fact, deciding to what degree each expert witness is to be believed, how much of all the evidence proffered or submitted should be considered, and the weight that should be given to any evidence. The article noted that “The trial courts are entrusted with the duty of gatekeeper when reviewing the admissibility of scientific expert testimony. The intention is to eliminate junk science and ensure that jurors only hear reliable expert testimony which will assist them in understanding key issues of fact presented at trial.” Ninety-some years ago, in Frye v United States (293 F 1013, DC Cir Ct App, 1923), the “general acceptance standard”was espoused; despite numerous court rulings further defining and tweaking this standard, the general acceptance standard or test is still in play today, particularly at the state level. The court in Frye noted

An in vivo study on the incidence and location of fracture in round orthodontic archwires

Objective The main objective of this in vivo study was to determine the incidence and location of fracture in round nickel–titanium (NiTi) and round stainless steel orthodontic archwires, both commonly used in orthodontics. Secondarily, this study sought to determine if there is any correlation between archwire fracture and gender, diameter of the archwire, arch type (maxillary/mandibular) or bracket used. Design In vivo study. Materials and methods One thousand orthodontic patients (1434 archwires) were evaluated during regular treatment visits to assess archwire fracture and location. The patients gender, age, type of archwire (round NiTi and round stainless steel), diameter of the archwire, arch type, location of fracture (anterior or posterior) and period of service before fracture were recorded. Statistical analysis Chi-square statistical test was utilized to address the frequency and the correlation between the different variables. Level of statistical significance (α) was set at 0.05. Results Twenty-five archwire failures were reported (1.7%) of the total sample size. All fractured archwires were NiTi, and 76% of the fractures were located in the posterior region. No statistical significance was found between archwire fracture and gender, arch type (maxillary/mandibular), archwire diameter or bracket type. Conclusion The frequency of archwire fracture during regular orthodontic visits is very low. The most common archwire fracture site is the posterior region. NiTi wires are the most commonly fractured archwire. No statistically significant correlation exists between archwire fracture and gender, arch type, bracket type or diameter of archwire.